Endometriosis is a common condition that affects women of reproductive age. It is a complex disease that occurs when endometrial cells (which normally line the inside of the uterus) grow outside of the uterine cavity, usually in the pelvic cavity.
It generally presents with 2 main kinds of symptoms:
- Pelvic Pain – during periods (dysmenorrhea), during sexual intercourse (dyspareunia), during bowel motions (dyschezia), before a period (pre-menstrual pain) and pain all the time (chronic pelvic pain)
- Infertility – endometriosis has been shown to reduce a couple’s chances of conception
Treatment involves both medical and surgical therapies. Treatment needs to be individualised to achieve the best outcomes for the patient.
Deep infiltrating endometriosis is a variant that is more aggressive and is often challenging to treat.
From a fertility perspective, it is important to diagnose endometriosis prior to fertility treatment if it is suspected from your personal history as it will affect your success rates of natural conception and possibly reduce your chances of IVF success.
If endometriosis is confirmed and removed, studies have shown a close to 2 fold increase in natural fertility, reducing your chance of requiring IVF.
Even if IVF is required, it is important to know if endometriosis is present, as treating endometriosis and performing IVF using alternative methods has been shown in some studies to improve the success rates of IVF.
Finally, it is important to see an Advanced Gynaecological Surgeon with adequate expertise for the surgery.
Endometriosis surgery can be complex, sometimes involving other specialist colleagues such as Colorectal Surgeons and Urologists. Studies have shown that complete resection of endometriosis at the first surgery leads to the best results. If repeat surgery is required, the benefit to pregnancy rates can be reduced by up to 50%.